Transcript Document 7153562

Understanding and Articulating the
Differences Between QI, Research or
Evidence Based Practice
Regina Taylor, MN, RN, ACNS-BC
Objectives
• Differentiate between quality improvement,
research and evidence based practice in
nursing
• Discuss strategies to ensure nurses at all levels
in all areas of practice understand and can
describe the differences
“A precursor to leading is understanding
the distinct differences, yet overlapping
associations between those 3 important
activities.”
(Newhouse, p.435)
Quality Improvement
• “Systematic, data-guided activities designed to
bring about immediate improvement in
healthcare delivery in particular settings.”
(Lynn, et al, 2007, p. 667*)
*= From ANCC Magnet Application Manual, 2008
Examples of QI
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Nursing Sensitive indicators
Performance Measures
Compliance checks
Example: Examination of use of intervention
at unit/facility level to attempt to decrease
patient falls
Nursing Research
• “A systematic search for knowledge about
issues of importance to the nursing
profession.” (Polit and Hungler, 1995*)
Example of Nursing Research
• Testing of an innovation that may impact
nursing practice in general (i.e. including
outside of the facility), such as to prevent falls
or injury from falls or pressure ulcers
QI or Research
QI Rapid Cycle Process
• Plan
• Do
• Study
• Act
Research Process
• Form hypothesis
• Study protocol/Data
collection
• Analysis and interpretation
of data
• Implementation into
practice
(Kring, p. 163)
QI or Research?
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Intervention
Risk
Audience
Data source
(Reinhardt and Ray, p.5)
Differences
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Philosophical underpinning
Purposes
EBP value
Generalizability
Beneficiaries
Risks and Burdens
Sample Size
Instruments
Design and methods
Implementation of findings
Social acceptance
(Kring, 2008)
Evidence-Based Practice
• “Conscious use/integration of the best research
evidence with clinical expertise and patient
preferences in nursing practice (adapted from
Sackett, et al, 2000*)
• EBP is a science-to-service model of engagement
of critical thinking to apply research-based
evidence (scientific knowledge) and practicebased evidence (art of nursing) within the context
of patient values to deliver quality, cost-sensitive
care.
Examples of EBP
• Use of evidence-based standards from
professional organization
• Use of research to guide protocols
• Institute for Healthcare Improvement (IHI)
bundles
• Specifics:
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Safe patient handling
Falls prevention
Pressure ulcer prevention
Restraint free environments
Integration of QI, EBP, and NR
QI
Met
Not Met
EBP
Evidence
No Evidence
NURSING
RESEARCH
If in doubt….
• Ask the experts
– Nurse researchers/scientists
– Quality Management
– Institutional Review Board
– Advance Practice Nurses
– Affiliated faculty
Strategies to ensure differentiation
• Educational seminars, including
– Grand Rounds (evidence based case study analyses)
– Webinars
• Reinforcement/Education at the bedside
• Documentation:
– EBP Fact Sheets
– Website
• Use of tools (Rating, differentiation, such as
Kring, p. 167)
• Journal Clubs (in person, on line)
Additional Strategies
• Establish reasonable budget (as separate FCP or line items) for
research
• Start with basic education for staff: Research process,
protection of human subjects, sharing your findings; enhance
all staff nurses ability to evaluate research using their selected
tool
• Assist staff with verbalizing how research is systematically
reviewed and used for evidence based practice; focus on
enculturation of research and EBP
• Articulate, and develop further, relationship with academic
affiliates and own research staff, including MDs, regarding
staff developing research skills/mentoring
• Facilitate attendance at research and EBP conferences.
• Assist with local research and EBP conferences
“Preparing the workforce involves
developing competencies in QI, EBP,
informatics, patient-centered care, and
interdisciplinary collaboration.”
(Newhouse, p. 435)
Magnet Requirements: Educational
• List continuing education programs (classroom or
electronic) and the number of nurses completing
each during the past 24 months. Do not include
orientation or inservice education. Include
programs covering…
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Research, including protection of human subjects
Evidence-based practice
Application of ethical principles
Quality improvement
Data and information analysis competencies
Evidence Based Practice SOE
• Describe and demonstrate
– The structure(s) and process(es) used to evaluate
existing nursing practice, based on evidence
– The structure(s) and process(es) used to translate
new knowledge into nursing practice.
– How translation of new knowledge into nursing
practice has affected patient outcomes.
Research SOE
• Provide annual report (research efforts and
presentations could be included here)
• Provide a budget summary for most recent
fiscal year, actual to budget, for nursing
education, conference attendance, and
research
Research SOE (cont.)
• The institution’s policies, procedures
(including IRB) and processes that protect the
rights of participants in research (NK 2)
• The credentials or related experience of all
external experts and other resources used to
develop and/or improve the infrastructures,
capacities, and processes for evidence-based
practice and research (NK4 and NK 4EO)
Research SOE (Cont.)
• Describe and demonstrate
– Consistent membership and involvement by at least one (1) nurse in the
governing body responsible for the protection of human subjects in research,
and that a nurse votes on nursing-related protocols.
– The structure(s) and process(es) used by the organization to develop, expand,
and/or advance nursing research.
– Nursing research studies from the past 2 years, ongoing or completed,
generated from the structure(s) and process(es) above. Provide a table
including:
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Study title
Study status
Principal investigator name(s)
Principal investigator credential(s)
Role(s) of nurses in the study
Study scope (internal to a single organization, multiple organizations within a system
independent organizations collaboratively)
• Study type (replication-yes or no; qualitative, quantitative, or both). Select one (1)
completed research study and respond to the four (4) criteria listed in the guidelines
provided.
References
• ANCC Manual, 2008
• Newhouse, R. (October, 2007). “Diffusing Confusion
between
Evidence
Based
Practice,
Quality
Improvement and Research.” Journal of Nursing
Administration. Vol 37. No. 10, 432-435.
• Kring, D. (June, 2008).
“Research and Quality
Improvement:
Different Processes, Different
Evidence.” MED/SURG Nursing. Vol. 17, No. 3, 162169.
• Reinhardt, A, and Ray, L. (February, 2003).
“Differentiating Quality Improvement from Research.”
Applied Nursing Research. Vol 16, No. 1, 2-8.
Questions?
Contact:
Regina Taylor, MN, RN, ACNS-BC
[email protected]
404-321-6111. ext. 6487
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